New Haven Independent

Rell’s Medicaid Cut: No Hablan Espanol?

by Melinda Tuhus | November 6, 2008 1:39 PM | Permalink | Comments (12)

luis%20perez%20cropped.jpg Luis Perez wanted to tell his doctor about his heart problem. His medication was making him feel worse, not better. Unfortunately, the doctor spoke just a little Spanish.

And Perez (pictured), who arrived in New Haven last year from Puerto Rico, knows just a little English, though, by necessity, he’s learning more.

“The doctor just told me to go see my cardiologist the next day,” Perez reported after his appointment the other day at New Haven’s Hill Health Center.

Perez is one of 22,000 Medicaid recipients in the state with limited English proficiency affected by a recent mid-year budget cut by Gov. M. Jodi Rell. Because of a suddent $300 million budget shortfall triggered by the Wall Street meltdown, Rell issues a series of cuts including eliminating $1.175 million in previously approved money for Medicaid medical interpreters services this year. Those on the front lines fear it will lead to increased disease and increased costs.

“The people that this helps the most are the growing number of poor who cannot access health care services because of limited English proficiency,” said Jeannette DeJesus, executive director of the Hartford-based Hispanic Health Council.

“Seventy-nine different languages are spoken in Connecticut,” she wrote in an email message. “The largest group is Spanish-speaking but [the problem] affects all LEP groups — this is why it has gotten such wide support across the state.”

DeJesus (pictured) wrote that the Hispanic Health Council brought together nearly 40 organizations that worked two years within communities across the state and with legislators to get the translators’ money approved.

She said the coalition will soon begin the work of getting the full amount restored. If they fail, she predicted “an increase in disease, and an increase in costs to our medical system” because those who cannot adequately speak English will not be able to access quality care and treatment. That can lead to medical errors that may require more treatment and medical intervention.

“Lack of understanding between doctor and patient may also lead to the patient not being able to follow instructions accurately,” she added. This results in increased time and treatment and therefore cost of care.

DSS spokesman David Dearborn called the medical interpretation program “one of several worthwhile programs or projects being delayed or deferred to help the state reduce the budget deficit.” Click here for the rescission document. (See page 15.)

New Haven State Sen. Toni Harp vowed to organize legislators to try to get the money restored. (Click here to read about that.)

One Center’s Efforts

One center with many Spanish-speaking Medicaid patients, New Haven’s Hill Health, has been trying to make do by enlisting other staffers. Sometimes that works. Sometimes it doesn’t. Luis Perez, for instance, is familiar with a nurse at Hill Health Center who speaks good Spanish and helps patients like him out on visits. But on the recent afternoon when he tried to tell his doctor about his heart, the nurse was not available.

Robert Kilpatrick, director of marketing and health education at Hill Health, said most patients have access to interpreters if they need them. But the interpreters are often employees pulled off their regular jobs to translate. He said the governor’s rescission “creates a situation in which we don’t have access to funds for people who have been trained specifically, and leaves us depending on existing staff and the telephone service we have called Language Line. That’s not the best way of doing it, but it’s seen as acceptable.”

Kilpatrick said one staffer has already taken a 40-hour medical interpretation course sponsored by the Eastern Area Health Education Center, and several more are planning to take it. Fluency in a second language besides English is a prerequisite for the course.

“I guess the hope is that if legislation ever gets implemented and money is put into it, these are the people who will be providing interpreting services.” He added that if people are not well trained, “You are opening yourself up to other problems, because there’s room for possible miscommunication.”

Other Staffers Step In

What about having a family member translate? One Republican candidate for State Senate this month, New Haven’s Melissa Papantones, argued that speakers of foreign languages should depend on relatives, not the state, to translate at the doctor’s office — the way her own grandparents did.

“”We all have to make some sacrifices to get everything back on track” on the budget, she said. “It’s hard to have an army of people available to speak the languages we’re dealing with. It’s not just Spanish. It’s hard to find interpreters.”

“People can bring family members in, and they do,” Kilpatrick said. “But it’s not a legitimate way of doing it, because there could be times when the information is confidential and shouldn’t be shared with family members, and there are times when the family member might not understand medical terms,” especially if the interpreter is a child.

Luis Perez offered another reason not to bring one of his kids to translate for his appointments — even though they’re picking up English faster than he is. He doesn’t want to take any of them out of school.

“Our hope,” Kilpatrick continued, “is to get enough funding to have a full-time person doing medical interpretation. That would be in Spanish; about half our patients are Spanish-speaking, although not all of them need interpretation. We also have a lot of other languages. Language Line reports each month on the calls they get from us. It’s been Vietnamese, French, African languages, Eastern European.”

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Comments

Posted by: lance | November 6, 2008 1:59 PM

screw entitlements. this guy probably has four kids and 10 grandkids living off our dime.

Posted by: Drop the Hammer | November 6, 2008 4:41 PM

The cost of the interpreter should be added to what the patient is already paying... oh wait. nevermind.

Posted by: cedarhillresident | November 6, 2008 4:46 PM

This is a bit scary. Everyone deserves decent healthcare!! If he qualify's for Medicare then he paid in people!!!!(right?)

Any who I say we take the money and advertise in Califorina to get the decent family that got the shaft thier tuesday and tell them we would love for them to move to CT and the small business's and thier tax dollar. Lets start marketing Rell a door has been opened! And maybe we will be able to afford this again!

Posted by: Ronald | November 6, 2008 5:32 PM

I have mixed feelings about this having seen the whole thing up close for many years. Here's why:
- using family members as interpreters is not acceptable. Who is going to discuss their sexual or drug history with a family member doing the translating?
- having to run the entire discussion through an interpreter doubles the length of the visit yet there is no compensation to the provider for the extra time spent
- there are people who have lived here for 10, 20 years and still request an interpreter.
Bottom line: trained interpreters should be the law, extra reimbursement for their service and the extra time required should be paid by the gov't. I have no suggestions for what to do when people live here for years and never learn the language.

Posted by: cedarhillresident | November 7, 2008 8:25 AM

Ronald
I stand with our Spanish speaking neighbors. But I do not stand by bi-lingual. Like many country's in Europe's. (yes Europe in not a country it is a continent :) right?) They require all that come to their different country's to learn the language. My guess is for reasons like this one. Because if you have a Spanish translator you need a polish, Italian ect. one.

Posted by: Bill | November 7, 2008 11:39 AM

It's simple learn English like all the other millions of non Spanish speaking immigrants have done.

Posted by: Oh Bama | November 7, 2008 6:27 PM

Here's a recent ruling where a physician lost a lawsuit for treating a patient who was deaf without a sign language interpreter, even though there was nothing wrong with the treatment he provided, and even though having the interpreter would cost 3-4 times as much as the patient paid for the visits. No matter what, the threat of a lawsuit trumps all.
http://www.pointoflaw.com/archives/2008/10/doctor-held-lia.php

Posted by: mrs.williams | November 7, 2008 7:30 PM

I agree with you Bill, People need to understand that they live inthe good ole United States and English is the primary language here, Learn the damn language. Everyone needs to stop making excuses for the hispanic community, if I go to PR not knowing there language will I receive special treatment. THey already have a FREE I.D.

Posted by: KAMB | November 7, 2008 8:08 PM

I have a few words for Luiz Perez . . . learn english or Adios Amigo!

Posted by: cedarhillresident | November 10, 2008 10:19 AM

hmmm ok as I read the post they seem a bit mean. I stand by my opinion that we should not be a bi-lingual country. But to make mean comments is just not necessary. This is an important issue with immigration laws on the verge of changing, this truly is an issue that needs to be taken up with that. We have millions of illegal immigrants here, many speak one dialect or another of Spanish. But not all are of Spanish descent, which means we would also need to have translators for all immigrants from asia and their many dialects, and other country's, we can not play favorites here. So if we offer it to one group it need to be offered to all. This starts getting very costly. Reality...14 million are here illegally. And we are most likely going to come up with some deal for them to stay. But I truly think that they no matter what county they are from should learn the language if they want the rights and the jobs. It is not an unfair request.

Posted by: Deborah Barclay | November 10, 2008 5:28 PM

I believe the taxpayer would be better served if all immigrants were required to enroll in ESL courses at taxpayer expense if they succeed; if not, the second and third time through the course is at their expense. Fail the 3rd time and your out.....I like this '3 strikes your out bill'....as a condition of citizenship. In the meantime, healthcare providers can use TECHNOLOGY for their interpreter needs.......internet, telenet, the possibilities are endless......might even pickup and CT can sell this expertise across the country. Heck, we could go global and give AT&T some competition overseas!It wouldn't be difficult to include a medical problem with diagrams, video, etc. incorporating the dual languages of provider and patient; with one click you can have your very own Chinese interpreter. Make sure the patient and interpreter have spent the 'introductory' time together before the Doc comes in.....Doc's get 'pissy' when they have to wait and 'frustrated' when techno isn't working appropriately.

Posted by: Lifer | November 10, 2008 8:10 PM

Deborah,
All of those translation methods cost money. Usually those who need interpreters are under-insured patients - at best they have Medicare, often Medicaid, both of which pay too little for doctor visits for a provider to break even, once overhead and staff salaries are paid. So if you add in the cost of an interpreter, the doctor is basically paying money to see the patient. There are currently phone-in services that provide interpreters via speaker phone for just about any language. That offers lots of options, but still costs money.

Rell’s Medicaid Cut: No Hablan Espanol?

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